Kaiser Permanente (SF) Medical Center Resident Supervision Guidelines
Specialty: Surgery
revised 09/07/01
- An attending physician is physically present while the procedure is being performed.
- An attending physician is consulted prior to performing the procedure.
- An attending physician may be consulted prior to performing the procedure if the resident has any issues regarding patient care
- The procedure may be maintained independently while under the direct and indirect general supervision of the residency program.
- An attending physician is consulted prior to performing the procedure.
N/A: Not applicable. Not done by this type of resident.
Nothing in this policy restricts the provision of emergency care required during a life threatening event.
| Procedure | Resident Level (PGY 1-5) | |||
|---|---|---|---|---|
| Abdominal wall hernias including umbilical and incisional (adult and pediatric) | 1 | 1 | 5 | 5 |
| Amputations to include above knee, below knee, and digital amputations | 1 | 1 | 1 | 5 |
| Appendectomy (open or laparoscopic) | 1 | 1 | 5 | 5 |
| Arterial line insertion | 2 | 2 | 2 | 4 |
| Breast biopsy | 1 | 1 | 1 | 5 |
| Cholecystectomy with or without cholangiograms (open only) | 1 | 1 | 1 | 5 |
| Conscious sedation | N/A | N/A | N/A | N/A |
| Consultations | 2 | 2 | 2 | 4 |
| Endotracheal intubation | N/A | N/A | N/A | N/A |
| Excision of skin lesions | 2 | 2 | 2 | 2 |
| Exploratory laparotomy with or without nimor ancillary biopsies such as lymph node biopsy, liver biopsy, resection of Meckel’s diverticulum | 1 | 1 | 1 | 5 |
| Fasciotomy | 1 | 1 | 1 | 5 |
| Hemodialysis catheter insertion | 1 | 1 | 1 | 5 |
| Incision and drainage of abscesses | 2 | 2 | 2 | 2 |
| Inguinal hernia (adult and pediatric) | 1 | 1 | 5 | 5 |
| Insertion of chest tubes | 1 | 1 | 1 | 2 |
| Insertion of temporary and permanent pacemakers | N/A | N/A | N/A | N/A |
| Lysis of adhesions/small bowel obstruction | 1 | 1 | 1 | 5 |
| Mastectomy | 1 | 1 | 1 | 5 |
| Other examinations under anesthesia of all body orifices | 1 | 1 | 1 | 5 |
| Other procedures | 2 | 2 | 2 | 5 |
| Paracentesis | 2 | 2 | 2 | 2 |
| Patient care orders | 4 | 4 | 4 | 4 |
| Pulmonary artery catheter insertion | 1 | 2 | 2 | 4 |
| Rectal surgery to include anal fistula excision, perirectal abscess drainage, hemorrhoidectomy, exam under anesthesia and fistulotomy | 1 | 1 | 1 | 5 |
| Sigmoidoscopy | 2 | 2 | 2 | 4 |
| Skin grafts | 1 | 1 | 1 | 5 |
| Thoracentesis | 2 | 2 | 2 | 2 |
| Transvenous cardiac pacemaker | N/A | N/A | N/A | N/A |
| Wound debridement | 2 | 2 | 2 | 2 |
This is not designed to be an exhaustive list of all possible procedures which are commonly performed at the bedside. Procedures which are similar, but not identical to those listed, may be performed with the supervision specified for the like procedure.
Note: these aspects of supervision are in addition to those specified in the individual residency program statement, the Professional Staff Rules and Regulations, and other applicable policies.